Provider Demographics
NPI:1659848745
Name:IADELUCA, JUSTINE FAYE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:FAYE
Last Name:IADELUCA
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CASSANDRA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3411
Mailing Address - Country:US
Mailing Address - Phone:401-529-2046
Mailing Address - Fax:
Practice Address - Street 1:80 LAMBERT LIND HWY
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1071
Practice Address - Country:US
Practice Address - Phone:401-739-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily